Provider Demographics
NPI:1629002654
Name:COMPLETE COLON CARE PC
Entity Type:Organization
Organization Name:COMPLETE COLON CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-763-3592
Mailing Address - Street 1:2093 HENRY TECKLENBURG DR
Mailing Address - Street 2:SUITE 307 EAST
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5744
Mailing Address - Country:US
Mailing Address - Phone:843-763-3592
Mailing Address - Fax:843-763-4171
Practice Address - Street 1:2093 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 307 EAST
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5744
Practice Address - Country:US
Practice Address - Phone:843-763-3592
Practice Address - Fax:843-763-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0359Medicaid
SC183142Medicaid
SCGP0359Medicaid
SC3656Medicare PIN